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General NPI Number Information
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NPI Number | 1245229228
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Entity Type | Individual
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Provider Name | CHRIS EDWARD LAWTHER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 6300 SHINGLE CREEK PKWY #250
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2124
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Country | US
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Telephone | 763-566-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 SHINGLE CREEK PKWY
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2179
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Country | US
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Telephone | 763-566-9006
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | AL8777027
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License Number State | MN
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